Cocaine addiction continues to be a major public health problem in the U.S. With no FDA- approved pharmaceutical therapy, treatment often relies on psychosocial interventions, known as behavior therapy. Despite some positive progress these psychosocial interventions have limited efficacy with problems like high dropout, untreated physical symptoms and high relapse rate. Our clinical experience and pilot studies suggest that Integrative Meditation (IM) from Chinese medicine may help clients engage in treatment, reduce cravings/ withdrawal symptoms, and increase treatment retention, which appear missed by a typical behavior therapy. IM is an adaptation or simplified form of mindfulness meditation. It may enhance existing therapies to help reduce withdrawal symptoms, increase treatment engagement, and prevent relapse through step-by-step therapist facilitation. This will be a brief Stage-1b therapy development study, based on a preliminary therapist manual and an observational study. The specific aims include: (1) To conduct a pilot randomized controlled trial of 66 outpatient cocaine users with 12 weekly facilitation meetings to assess feasibility of recruiting and retaining cocaine addicts, and to determine effect size of IM-augmented treatment in comparison with Non-directive therapy (NT) control, with both groups receiving standard treatment as usual (TAU), (2) To examine the changes in attention networks and negative mood as possible mediators of treatment outcomes between the two groups. Treatment outcomes will be assessed at baseline, week 4, 8 and 12, and at the follow-up 3 months after intervention. Primary outcomes include cocaine urine toxicology, number of weeks in treatment, and intensity of cocaine use. Secondary outcome measures include Addiction Severity Index (ASI) composite scores, use of alcohol and other drugs, heart rate variability, craving, depression, anxiety, and self-efficacy. Additional measures are proposed to aid in understanding possible underlying mechanisms of IM's effect on attention networks and the autonomic nervous system. A diverse team experienced in meditation and behavior therapy development is brought together to conduct the proposed R21 project, and prepare for a full therapy development study. PUBLIC HEALTH RELEVANCE: Given the fact that cocaine addiction continues to be a major public health problem in the U.S. without a sound solution, the proposed study will implement a brief Stage-I study of adding Integrative Meditation (IM) as a self-care component to the current outpatient treatment to improve treatment outcome for cocaine addiction. IM requires minimum therapist involvement and can serve as an adjunct to other existing treatment modalities. It may not only provide the needed treatment for physical and psychological symptoms during withdrawal or abstinence at the time when a patient needs it, but also quickly engage patients in the treatment and improve patients'self-efficacy and attention network that could help keep them away from relapse. Therefore, if the study verifies its efficacy and feasibility, IM may become an important cost- effective tool in the field of addiction treatment.